=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316343056
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA DRAPER PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2014
-----------------------------------------------------
Last Update Date | 11/07/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 483 W BOCKMAN WAY
-----------------------------------------------------
City | SPARTA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38583-1832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-836-3230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 936 PLEASANT SHADE HWY
-----------------------------------------------------
City | PLEASANT SHADE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37145-3302
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-735-7164
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 38607
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------